Prognostic value of integrative analysis of electrical and mechanical dyssynchrony in patients with acute heart failure

Background: Left ventricular mechanical dyssynchrony has been shown to provide significant clinical values for chronic heart failure (HF) and cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate whether electrical dyssynchrony combined with mechanical dyssynchrony has an incremental benefit over electrical dyssynchrony or mechanical dyssynchrony alone to predict clinical events in patients with acute heart failure (AHF). Methods: Ninety-six AHF patients who received standard 12-lead ECG, gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and echocardiography were enrolled. Thirty-two normal subjects were collected as the control group to get the normal database of mechanical dyssynchrony. The end point is the composite of all-cause death and heart transplantation. Electrical dyssynchrony was defined as QRS duration \u3e 120 ms. Mechanical dyssynchrony was defined as \u3e mean + 2 × SD phase standard deviation (PSD) or phase bandwidth (PBW) based on our normal database. Results: During the follow-up of 28 ± 10 months, complete data were obtained in 92 patients. 26 (28.3%) Patients who reached the end point were classified into the event group. There were no significant differences in PSD or PBW between the event and non-event groups. However, PBW \u3e 77.76° was independently associated with the end point in the univariate and multivariate analysis (hazard ratio 2.92, 95% confidence interval 1.00-8.47, P =.049; hazard ratio 3.89, 95% confidence interval 1.01-14.97, P =.048). The Kaplan-Meier curve with a log-rank test showed that the end point rate was significantly higher in the patients with PBW \u3e 77.76° (log-rank P =.039). Moreover, the ROC curve analysis showed that the area under the curve (AUC) for predicting end point events by the integrative analysis of QRS \u3e 120 ms and PBW \u3e 77.76° was significantly improved compared to QRS duration \u3e 120 ms (AUC: 0.75 vs 0.68, P =.001) or PBW \u3e 77.76° (AUC: 0.75 vs 0.62, P =.049), respectively. The model of combined electrical and mechanical dyssynchrony yielded a further significantly improved risk prediction for adverse events in the global χ2. Conclusions: The combination of QRS duration \u3e 120 ms and PBW \u3e 77.76° was an independent predictor of all-cause death and heart transplantation in AHF patients. The integrative analysis of electrical and mechanical dyssynchrony provides incremental prognostic value for clinical use